Care Closer to Home

STHe Telemedicine Partnership Increases Rural Access to Specialty Care

After much due diligence, Saint Thomas Health (STHe) recently partnered with Cisco Systems to increase availability and access to specialty care to patients in rural Tennessee counties. By pairing clinical skill with an advanced telemedicine platform, patients and physicians are able to seamlessly interact in a ‘face-to-face’ manner despite geographic separation. (See related story below.)

“We were looking for a number of years for a successful telehealth partner we could bring to the region,” explained Jason Dinger, vice president of STHe. Although the health system reviewed many options, Dinger said Cisco had three key strengths that set the San Jose, Calif.-based company apart from others.

First, he noted, Cisco’s HealthPresence™ solution is a “proven technology in providing high-definition video in numerous settings.” The large screen was also attractive to foster natural interaction during appointments. Unlike Skype or other systems using a traditional computer monitor, he added, “the video is actually life size. It’s a truly different experience for a patient.” Dinger continued, “The third thing is that all of the clinical equipment is built into the system so you can do a full intake and exam with a patient. That was the real breakthrough in many ways.”

In November 2010, the partners launched a cardiovascular pilot program to bring the expertise of Saint Thomas Heart to residents in Franklin and Hickman counties. Now past the pilot stage, Dinger noted, “We’re fully implemented in the two communities and should hopefully have online another four by fall.” Currently, there are physician pods at Saint Thomas Hospital in Nashville and remote sites at Saint Thomas Heart Clinic in Winchester, Tenn. and in Centerville, Tenn. at Hickman Community Hospital. Already, the program has expanded to include primary care, and Dinger said the goal is to add additional specialties this fall plus physician pod sites at Baptist Hospital.

Royal Tatnull, director of Care at a Distance for STHe, explained how a typical appointment proceeds. Upon arrival at a nearby HealthPresence site, a patient is greeted by a medical assistant who serves as the remote physician’s onsite hands. The patient and onsite medical personnel, which could also be a registered nurse or nurse practitioner depending on the acuity level at a given site, position themselves in front of the system’s large profile measuring approximately 7 feet by 7 feet with a 37-inch screen. Rather than being frustrated by not being in the same room as a patient, physicians have actually praised the system’s video quality and amplified volume as being superior to the naked eye and normal hearing.

“They use 1080p technology, which is better than 20/20 vision,” said Tatnull, who called the equipment ‘super high def.’

Don Chomsky, MD, a cardiologist with Saint Thomas Heart, said the system’s capabilities have exceeded his expectations. “The image quality is fairly unbelievable. You really feel like you’re having a face-to-face interaction with the patient,” he said. “In terms of the technical issues of the acoustics of listening to the heart and lungs, the equipment actually allows you to hear things that really you wouldn’t hear with a traditional stethoscope because it’s somewhat amplified. So if anything, I would say some of the things we kind of listen for are actually more easily heard through the system than with a typical interaction.”

An additional exam feature for patients using HealthPresence is a smaller, secondary computer screen that allows the onsite staff person and the patient to witness everything the physician is seeing in real time … including the inside of the ear or a peak down the throat. “The patient is able to fully participate with their care,” noted Tatnull. Dinger added, “You can also listen to your heartbeat on your own headset. It’s very cool.” He said surveys regarding the telemedicine initiative have shown patients like the system as much or more than traditional face-to-face visits. “We’re seeing patients get more engaged in their care and get more motivated in managing their condition,” Dinger continued.

Two of the biggest benefits to patients are the gifts of time and access to specialty care. “Our patients have been very vocal in the fact that this is allowing them to see the doctor more often and is less of a burden on them and their caregivers,” Dinger said. He added that it is often a struggle for individuals to take time off work and spend hours traveling to and from Nashville to receive quality specialty care. “The fact that we can help them 15 minutes from home is very gratifying.”

STHe’s significant investment in a number of mobile initiatives underscores the health system’s commitment to addressing access issues. In addition to HealthPresence sites, STHe also has a Mobile Medical Unit with one traditional exam room and another exam space equipped with a satellite-enabled HealthPresence unit to make it possible to hold telemedicine consults in remote areas of Tennessee and southern Kentucky or in disaster situations.

This summer, STHe launched “Our Mission in Motion” — a mobile mammography outreach initiative in conjunction with the Susan G. Koman Foundation that is equipped with Hologix digital mammography equipment. The program targets employed, underinsured and uninsured women throughout a 12-county area in Middle Tennessee, providing screening mammograms free of charge to women whose income is at or below 200 percent of federal poverty guidelines. The health system also recently debuted the Mobile Simulation Lab, which is designed to deliver the most technologically advanced, realistic emergency room and ambulance settings to any remote location for training purposes.

“One of the things we are focused like a laser on here is providing greater access to all types of care, particularly specialty care, in the outlying regions,” Dinger concluded. “At the heart of it … as an organization … we are committed to providing holistic, reverent care in each of the communities we serve.”


 Related Story

TriStar Telemedicine Program Delivers Specialists to Rural Facilities

TriStar has recently deployed a new telemedicine program to virtually deliver expertise in a variety of medical specialties to patients in rural communities. All the on-call specialist needs is a wireless connection, and he or she can be at a patient’s bedside in a matter of seconds.

This technology is bringing experts from around the world to facilities such as Horizon Medical Center so that patients from Dickson and other smaller communities have the same access to care as their counterparts in larger urban areas. Using the portable equipment, physicians can zoom in on the patient's features, check X-rays, ask questions and even conduct physical exams.

"It does not replace services but provides resources that are not always available in rural areas,” said Horizon Medical Center Director of Emergency Services, Gabe Triplett, RN.

Triplett said the telemedicine program utilizes a mobile cart that can be taken to the patient's bedside. The equipment allows doctors, nurses and other providers in remote outposts to consult with specialists about a patient's condition.

Initially, this new technology is being used to treat strokes but will eventually be used to treat other conditions. “We’re taking the medicine to the patient instead of making the patient come to the medicine,” said Triplett. “The least amount of time it takes to dissolve the clot, the least amount of damage that’s going to take place.”

The stroke telemedicine initiative is particularly important because Tennessee ranks first nationally for age-adjusted deaths per 100,000 from stroke, according to most recent data tracked by the American Heart Association. In 2007, there were 3,421 deaths from stroke in Tennessee according to the Centers for Disease Control and Prevention. Other states in the stroke belt include Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina and South Carolina.

The TriStar Telemedicine Network is the largest telemedicine network in Middle Tennessee for strokes. The equipment is installed at Centennial, Skyline, Southern Hills, StoneCrest and Horizon medical centers. Three more hospitals will have the program this fall. Ultimately, TriStar plans to expand the rollout to all 19 of its hospitals and eventually extend the program to include non-HCA hospitals in rural communities.